Background/Purpose: Clinically suspect arthralgia (CSA) has been associated with an increased risk of developing inflammatory arthritis (IA). Subclinical inflammation on imaging tests may help to identify which CSA participants are at a higher risk of progression. This systematic review aimed to determine and compare the diagnostic accuracy of imaging tests for the prediction of rheumatoid arthritis (RA)/IA progression in participants with CSA.

Methods: We searched MEDLINE, Embase and Web of Science from 1987 to March 2024. Studies evaluating any imaging tests in participants with CSA without clinical synovitis against a reference standard (i.e. RA classification criteria, DMARD initiation or development of RA/IA defined by a rheumatologist and/or by clinical examination) were eligible. Two authors independently extracted data and assessed validity according to QUADAS-2. We estimated summary sensitivities and specificities with 95% confidence intervals (95% CI) for each imaging characteristic and fitted bivariate and hierarchical SROC models for meta-analysis where possible.

Results: We identified 18,044 unique studies in the initial study screening, of which 222 papers were selected for full text reading. We found 39 eligible studies including 42 cohorts, of which 12 evaluated MRI (n=2,782; 19% developed RA/IA), 26 evaluated ultrasound (US)(n=6,805; 25% developed RA/IA) and 10 evaluated other imaging tests (n=3,362; 20% developed RA/IA). Summary sensitivity and specificity for MRI synovitis in at least one joint were 45% (95% CI 29%-62%) and 84% (95% CI 66%-94%), respectively (4 studies). Summary sensitivity and specificity for MRI tenosynovitis were 62% (95% CI 44%-78%) and 73% (95% CI 49%-88%), respectively (3 studies). Summary sensitivity and specificity for US Power Doppler ≥1 in at least one joint were 37% (95% CI 18%-60%) and 90% (95% CI 82%-94%), respectively (7 studies).  Summary sensitivity and specificity for US GS≥2 were 64% (95% CI 31%-87%) and 64% (29%-88%), respectively (5 studies). Summary sensitivity and specificity for radiographic erosions were 13% (95% CI 10%, 17%) and 91% (95% CI 91%, 94%), respectively (2 studies, n=1,449; 22% with IA/RA). Lack of consensus regarding imaging tests positive threshold definitions limited meta-analysis for other imaging features.

Conclusion: The results of this systematic review suggest that in the absence of clinical synovitis, imaging tests can identify subclinical inflammation which may help identify patients at risk of progression to IA/RA. However, the evidence is heterogenous and of variable quality. Further studies with larger sample sizes, longer follow up times and uniform imaging test scoring, are warranted to determine whether imaging characteristics, in combination with clinical information, can predict RA in this population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/do-imaging-tests-have-a-role-in-predicting-progression-to-rheumatoid-arthritis-in-people-with-clinically-suspect-arthralgia-a-systematic-review-meta-analysis/